Provider Demographics
NPI:1942351317
Name:MATHIS, CYNTHIA RENEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 CHAIN BRIDGE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5703
Mailing Address - Country:US
Mailing Address - Phone:703-401-5394
Mailing Address - Fax:
Practice Address - Street 1:1483 CHAIN BRIDGE RD STE 301
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5703
Practice Address - Country:US
Practice Address - Phone:703-401-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist